ABSTRACT
Abstract: Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.
Subject(s)
Humans , Male , Aged , Leprosy, Borderline/etiology , Leprosy, Lepromatous/etiology , Dermatitis, Exfoliative/complications , Biopsy , Leprosy, Borderline/diagnosis , Leprosy, Borderline/pathology , Leprosy, Lepromatous/diagnosis , Leprosy, Lepromatous/pathology , Dermatitis, Exfoliative/diagnosis , Dermatitis, Exfoliative/pathology , Diagnosis, DifferentialABSTRACT
A síndrome da pele escaldada estafilocócica é uma dermatose esfoliativa rara no adulto, que acomete cerca de 0,09 a 0,56 por milhão de habitantes. É causada por exotoxinas produzidas por Staphylococcus aureus e manifesta-se com a formação de lesões bolhosas difusas pelo corpo. O diagnóstico é feito por meio de exame físico, hemocultura, cultura de sítio infectado e análise histopatológica. As medidas de suporte e a antibioticoterapia são a base do tratamento. Este relato descreve o raro acometimento de paciente idoso e evidencia a associação da doença com a imunossupressão. A presença de lesões em mucosa oral é um achado atípico e similar a um dos principais diagnósticos diferenciais da síndrome da pele escaldada estafilocócica: a necrólise epidérmica tóxica. É de suma importância diferenciá-las por meio de análise histopatológica das lesões de pele devido às formas inerentes de tratamento e à gravidade. O relato alerta para a importância do rápido reconhecimento do diagnóstico, a fim de introduzir tratamento adequado precoce, evitando os riscos da terapia inadequada e das complicações naturais da doença. Desta forma, é possível alcançar um desfecho positivo em uma doença de baixa prevalência e alta mortalidade no adulto.(AU)
The Staphylococcal Scalded Skin Syndrome is a rare exfoliative dermatitis in adults, affecting about 0.09 to 0.56 per million inhabitants. It is caused by exotoxins produced by Staphylococcus aureus and is manifested by the formation of diffuse bullous body lesions. The diagnosis is made through physical examination, blood culture, infected site culture, and histopathology. Supportive measures and antibiotics are the mainstay of the treatment. This report describes the rare involvement of an elderly patient, and highlights the association of the disease with immunosuppression. The presence of lesions in the oral mucosa is an atypical finding, being similar to one of the main differential diagnosis of the Staphylococcal Scalded Skin Syndrome: the Toxic Epidermal Necrolysis. It is very important to differentiate them through histopathology of the skin lesions due to the peculiar forms of treatment and the severity of the diseases. The report highlights the importance of rapid recognition of diagnosis in order to introduce early appropriate treatment, avoiding the risks of inappropriate therapy, and natural complications of the disease. This way, it is possible to achieve a positive outcome in a disease of low prevalence and high mortality in adults.(AU)
Subject(s)
Humans , Male , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Dermatitis, Exfoliative/diagnosis , Staphylococcal Scalded Skin Syndrome/diagnosis , Staphylococcal Scalded Skin Syndrome/drug therapy , Dermatitis, Exfoliative/drug therapyABSTRACT
Eritrodermia, doença com baixa incidência, caracterizada por eritema em mais de 80% da pele, com limitação importante da qualidade de vida do paciente. Pode apresentar diversas causas, sendo as mais prevalentes dermatoses pré-existentes e uso de fármacos. Frente ao quadro de eritrodermia, torna-se obrigatório a exclusão de neoplasia como causa.
Erythroderma, is an uncommon skin disorder, characterized by erythema in more than 80% of the skin and significant limitation the quality of life. The disease has various causes, the most prevalent are pre-existing dermatoses and drug use. In the moment of diagnose of erythroderma, is mandatory to exclude malignancy as the cause.
Subject(s)
Dermatitis, Exfoliative/diagnosis , Dermatitis, Exfoliative/etiology , Dermatitis, Exfoliative/pathology , Dermatitis, Exfoliative/therapyABSTRACT
It is a case study of a 62-yr-old female with crusted (Norwegian) scabies, which appeared during her treatment with systemic and topical corticosteroid therapy, under the diagnosis of erythroderma. In the same time, the patient had been suffered from hypothyoidism, and her skin changes were misdiagnosed, because it was thought that they are associated with her endocrine disorder. Suddenly, beside the erythema, her skin became hyperkeratotic, with widespread scaling over the trunk and limbs, and crusted lesions appeared on her scalp and ears. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites and eggs. Repeated topical treatments with lindan, benzoyl benzoat and 10% precipitated sulphur ointment led to the complete resolution of her skin condition.
Subject(s)
Female , Humans , Middle Aged , Administration, Topical , Antiparasitic Agents/therapeutic use , Dermatitis, Exfoliative/diagnosis , Diagnostic Errors , Glucocorticoids/administration & dosage , Scabies/diagnosis , Skin/pathologyABSTRACT
We report a HTLV-I positive infant, whose infection was confirmed by polymerase chain reaction. The infant presented with an acute, severe, generalized eczema, exfoliation and severe erythroderma that yielded to an acute proteic malnutrition and frequent staphyloccocal infections, unresponsive to treatment, since the second month of life. Immunodeficiencies from other origin and other causes of erythroderma were ruled out. The histopathology studies and clinical course yielded to the diagnosis of infective dermatitis associated to HTLV-I. A review of the literature is performed.
Se presenta un niño infectado por virus HTLV-I por vía vertical, confirmado por reacción de polimerasa en cadena, quien, a partir del segundo mes de vida, presentó un cuadro de eccema agudo severo generalizado, que llegó a la eritrodermia y exfoliación masiva, provocando una desnutrición proteica aguda e infecciones repetidas por Staphylococcus aureus, de difícil manejo. Se descartaron inmunodeficiencias de otro origen, así como otras causas de eritrodermia. Posteriormente, de acuerdo con la evolución clínica y con las biopsias, se interpretó el cuadro como una dermatitis infecciosa asociada a HTLV-I. Se revisa la literatura en relación a la infección por HTLV-I.
Subject(s)
Humans , Infant , Male , Dermatitis, Exfoliative/virology , HTLV-I Infections/complications , Staphylococcal Skin Infections/etiology , Dermatitis, Exfoliative/diagnosis , Dermatitis, Exfoliative/drug therapy , HTLV-I Infections/diagnosis , HTLV-I Infections/drug therapy , Severity of Illness Index , Staphylococcal Skin Infections/diagnosis , Staphylococcal Skin Infections/drug therapy , Staphylococcus aureus/isolation & purificationSubject(s)
Humans , Male , Infant , Dermatitis, Exfoliative/diagnosis , Dermatitis, Exfoliative/microbiology , Staphylococcal Scalded Skin Syndrome/diagnosis , Staphylococcal Scalded Skin Syndrome/drug therapy , Anti-Bacterial Agents/therapeutic use , Cloxacillin/therapeutic use , Diagnosis, Differential , Dermatitis, Exfoliative/etiology , Metabolic Diseases/complications , Communicable Diseases/complications , Skin Diseases/complications , Penicillins/therapeutic use , Treatment OutcomeABSTRACT
Erythroderma is a clinical manifestation of dermatoses from different causes. Our objective was to determine its incidence, causes and clinicopathological features. Clinical, laboratory, and biopsy materials of 49 patients diagnosed as having erythroderma were reviewed. They were treated in our department over a 10-year period (1985 through 1994). The male-female ratio was 2:1. The mean age at diagnosis was 51.7 years. The most common causative factors were drugs (38.77%) and preexisting dermatoses (26.5%). Hepatomegaly, jaundice and abnormal liver function tests were found more commonly in the drug allergy group, while in cases with preexisting dermatoses nail involvement was a common finding. Clinicopathologic correlation in our study did not inform the etiology because it showed chronic nonspecific dermatitis or psoriasiform dermatitis, without any clue as to its origin. Drug-induced-erythroderma had an acute onset and a good prognosis with rapid resolution when the causative drug was withdrawn, while histopathology and laboratory findings were largely unrewarding.
Subject(s)
Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Dermatitis, Exfoliative/diagnosis , Female , Humans , Incidence , Male , Middle Aged , Risk Factors , Sex Distribution , Thailand/epidemiologyABSTRACT
The main challenge in erythroderma is to find the underlying cause. Skin biopsy is one of the important investigations in this inflammatory disorder. Our aim was to evaluate the diagnostic value of skin biopsy in determining the aetiology of erythroderma. Between January 97 and May 99, fifty skin biopsies were performed in 48 patients of erythroderma in the Department of Dermatology, Mayo Hospital, Lahore. Histological findings in each case were correlated with the clinical diagnosis. Except for 3 cases, all the patients were adults. Twenty-seven [54%] biopsy sections were rewarding helping us to reach a diagnosis regarding the aetiology of erythroderma. In 52% sections there was a good clinicopathological correlation. These included diseases like psoriasis, eczema, pemphigus foliaceous, pityriasis rubra pilaris and bullous ichthyosiform erythroderma. In those cases where a diagnosis was possible, the histopathological features of the underlying disorder was retained. Sixteen [33.33%] patients with erythroderma had non-specific findings on histopathology. Five clinically undetermined cases [10% of the sections] had typical eczematous changes. In conclusion, skin biopsy is a very useful investigation in cases of erythroderma since the histopathological features of the underlying disorder are recognizable in more than half the cases. Biopsies if repeated at intervals may prove to be useful. Two-third cases of psoriatic erythroderma can be confidently diagnosed on histopathology
Subject(s)
Humans , Male , Female , Dermatitis, Exfoliative/diagnosis , Skin/pathology , BiopsyABSTRACT
La eritodermia es una entidad sindromática para la cual puede ser difícil establecer el diagnóstico etiológico, tanto desde el punto de vista clínico como del histopatológico. Aproximadamente en el 23 por ciento de los pacientes no es posible determinar la causa, denominándose entonces como eritrodermia idiopática. Se ha considerado a ésta como el estadio inicial de una micosis fungoide, ya que aparentemente hasta el 30 por ciento de estos pacientes pueden evolucionar hacia esta entidad. En la piel y sangre de pacientes con micosis fungoide y síndrome de Sézary, respectivamente, se han encontrado niveles elevados de la molécula de adhesión asociada a la función leucocitaria-1 y de las células T cooperadoras. Con el objetivo de medir por citometría de flujo en sangre venosa: célular NK (®natural killer¼), células T cooperadoras, células T citotóxicas, índice célular T cooperadoras/citotóxicas y las moléculas de adhesión asociada a la función leucocitaria alfa y beta en los diferentes grupos etiológicos de eritrodermia, se realizó un estudio tansversal, observacional prospectivo, de casos y controles. Se incluyeron 22 pacientes con diagnóstico clínico de eritrodermia de diferente etiología (dermatosis preexistentes, medicamentos, neoplasias e indiopáticas) además de 12 controles sanos. Se demostró una disminución estadísticamente significativa en las células NK, en todos los grupos problema; elevación también estadísticamente significativa en los linfocitos T cooperadores y en la molécula asociada a la función leucocitaria beta sólo en el grupo de eritrodermia idiopática. Las determinaciones del índice células T cooperadoras/citotóxicas y de la molécula asociada a la función leucocitaria alfa no variaron significativamente en comparación al grupo control. La elevación de células T cooperadoras y de la molécula asociada a la función leucocitaria beta puede representar un marcador de las eitrodermias idiopáticas; grupo de riesgo para el desarrollo de micosis fungoide. Se requiere a futuro de estudios longitudinales para la obsevación del comportamiento de estos marcadores celulares durante la evolución del cuadro eritrodérmico
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Mycosis Fungoides/complications , Dermatitis, Exfoliative/diagnosis , Dermatitis, Exfoliative/etiology , Data Interpretation, Statistical , Flow Cytometry/methods , Flow Cytometry , Diagnosis, Differential , Cell Adhesion MoleculesABSTRACT
Se presentan dos formas graves de psoriasis infantil, el primero para remarcar los factores precipitantes tales como el uso de corticoides orales y PUVA en la eritrodermia psoriásica y el segundo por las escasas comunicaciones de psoriasis pustulosa generalizada en niños menores de un año de edad; se comenta el tratamiento exitoso con el etretinato en ambos casos.
Subject(s)
Humans , Male , Child , Dermatitis, Exfoliative/complications , Etretinate/therapeutic use , Psoriasis/complications , Adrenal Cortex Hormones/adverse effects , Dermatitis, Exfoliative/diagnosis , Dermatitis, Exfoliative/drug therapy , Etretinate/administration & dosage , Psoriasis/diagnosis , Psoriasis/drug therapy , PUVA Therapy/adverse effectsSubject(s)
Humans , Skin Diseases/complications , Dermatitis, Exfoliative/diagnosis , Dermatitis, Exfoliative/drug therapy , Erythema Multiforme/diagnosis , Erythema Multiforme/drug therapy , Pemphigoid, Bullous/diagnosis , Pemphigoid, Bullous/drug therapy , Pemphigus/diagnosis , Pemphigus/drug therapy , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/drug therapy , Sunburn/diagnosis , Blister/diagnosis , Blister/therapyABSTRACT
Se llevó a cabo un estudio retrospectivo de 23 pacientes con eritrodermia (ED) vistos en el Instituto Nacional de la Nutrición durante un periodo de 9 años. Las características clínicas fueron similares a otras series publicadas en la literatura. Las causas más frecuentes fueron: Psoriasis 22 por ciento, dermatitis atópica 17 por ciento, micosis fungoides 17 por ciento, eritrodermia idiopática 17 por ciento, reacción medicamentosa 13 por ciento y otros 21.6 por ciento. En un promedio de 22 meses después del diagnóstico el 78 por ciento de los casos se encontraban en remisión, siendo la prednisona la droga más usada en el tratamiento (21 casos). Cinco enfermos murieron, tres de ellos por infecciones asociadas al tratamiento. Los datos de mayor utilidad para el diagnóstico diferencial fueron la historia de dermatosis previa, o exposición a medicamentos, la presencia de adenomegalia, eosinofilia, la biopsia de piel y en algunos casos la de ganglio. Se propone un algoritmo de estudio de ED a partir de la historia clínica y de los resultados de laboratorio e histopatología
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Clinical Laboratory Techniques/statistics & numerical data , Dermatitis, Exfoliative/diagnosis , Dermatitis, Exfoliative/physiopathology , Prednisone/administration & dosage , Prednisone/therapeutic useSubject(s)
Humans , Skin Diseases/diagnosis , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Exfoliative/diagnosis , Emergencies , Erysipelas/diagnosis , Erythema Multiforme/diagnosis , Skin Diseases, Vesiculobullous/diagnosis , Skin Diseases, Vesiculobullous/drug therapy , Spider Bites/diagnosis , Stevens-Johnson Syndrome/diagnosis , Sunburn/diagnosisABSTRACT
Os autores apresentam um caso recentemente observado de Pityriasis lichenoides et varioliformis acuta (PLEVA) que apresentou involuçao espontânea e fazem sucinta revisao dos aspectos terapêuticos da dermatose.